Aneurysm of the renal artery: what is it, symptoms, diagnosis, treatment

Kidneys are supplied with blood along the arteries - wide vessels carrying oxygen-saturated blood to the organs. There are many defects of the renal artery and a fairly rare pathology - an aneurysm. This is often acquired disease, post-traumatic and difficult to diagnose( due to the absence of symptoms).According to the ICD-10 aneurysm of the renal artery has the code 172.2.

Aneurysm of the renal artery - what is it?

An aneurysm is a pathological protrusion of the vein or artery wall caused by its stretching or thinning. In this case, the lumen of the vessel increases at least twice in the place of aneurysm formation. For any aneurysm is characterized by a constant increase, leading to rupture and extensive hemorrhage.

Pathogenesis and forms of

At the time of an aneurysm of the renal artery can be divided into congenital and acquired. Congenital limited arterial dilations are characteristic of genetic diseases( for example, the Marfan syndrome) and is extremely rare. More often an aneurysm of the renal artery is traumatic in character and refers to acquired pathologies.

Also acquired are their occurrence with:

• syphilitic mezaortite;
• nonspecific aortoarteriitis;
• atherosclerosis;
• severe infectious diseases affecting the elasticity and vascular density. .

Rassaging aneurysms are characteristic of large central vessels.

Mechanism of occurrence:

1. Rupture of the inner shell of the vessel wall while maintaining the middle and outer layers.
2. Blood in the formed space between the middle layer and the inner shell( formation of a "pocket" in the wall of the vessel).
3. Longitudinal stratification of the vessel wall under pressure of blood flow.

With false( extrarenal) aneurysms, protrusion is formed from the connective tissue layer, without the involvement of muscle fibers. The formation of false aneurysms occurs most often after a traumatic injury: penetrating injury( knife, gunshot, etc.), less often - after a blunt trauma of the lumbar region and kidneys. It forms a hematoma, the walls of which on the 15-20th day after injury become a dense capsule of a false aneurysm.

In the form of a pathological protrusion, we can distinguish:

• Spindle-shaped( fusiform), arising from diffuse circular lesion of the wall. In a limited area of ​​the vessel, the walls of the vessel become thin and stretched. This leads to an expansion of the lumen of the artery, which is fraught with a violation of the normal flow of blood. The funnel-shaped vortices are formed, the walls of the vessel are stretched even more.
• Sachet - occurs when a local lesion of the walls of the renal artery. This form is characteristic of false aneurysms formed after the rupture of the vessel wall and the appearance of a hematoma. From a thin hole in the walls of the vessel, the blood enters the aneurysmal cavity, which thickens and joins the clot already present on the periphery.

Reasons for

The cause of aortic aneurysm development can be:

1. Congenital abnormalities of the medial membrane of the vessels( media) or connective tissue dysplasia.
2. Infectious diseases affecting the connective tissue layer of vessels( eg syphilis).
3. Harmful habits( alcoholism, drug addiction, smoking).
4. Pathologies and diseases of the cardiovascular system( eg, atherosclerosis).
5. Elderly - there is a natural weakening of the walls of blood vessels and other tissues due to a lower production of collagen and elastin.
6. Injury of the renal artery( surgical intervention, penetrating wound, dull lumbar injury, etc.).

A provoking factor in the development of an aneurysm of the renal artery is considered to be diabetes.

Symptoms and signs

In the early stages of aneurysm development, subjective sensations do not arise. As the aneurysmal formation increases, the pressing or pulling pain in the waist and sides of the affected side begins to be felt. This is due to the increasing pressure on the tissue surrounding the aneurysm. If the ureter is squeezed, the kidney function is severely impaired, kidney failure develops, which can provoke hypertension and infarction of the kidney( development of necrosis).There are symptoms of intoxication( nausea, sometimes reaching vomiting, headache, malaise).

Sickle aneurysms are characterized by the formation of blood clots from the blood clots with hematomas, so there may be thrombosis of the renal artery. In this case, the kidney infarction develops much faster than in the case of kidney failure. The pain is more pronounced, can radiate into the groin, genitals, thigh or central abdomen. Hypertension develops, overall well-being worsens.

Renal aneurysm of the renal artery is extremely rare. But for the separation of the vessel is characterized by the appearance of acute intense pain( with lesion of the renal artery - in the lumbar region, from the side of the lesion).Also accompanied by a sharp and pronounced deterioration in the general condition.

The main symptoms of rupture of the aneurysm of the renal artery:

• Severe pain in the back, side or abdomen.
• Increased pain syndrome.
• Rapid deterioration of the general condition until loss of consciousness.
• Drop in blood pressure.
• Heart palpitations.
• Severe pallor of the skin.

Diagnosis

It is necessary to conduct a number of non-invasive studies that allow one to see the aneurysm of the renal artery.

The most commonly used research methods are:

• ultrasound diagnostics. The easiest way to get information about the condition of internal organs without using expensive technologies. Conduct ultrasound of the kidneys and ureters.
• Angiography( X-ray examination with the introduction of contrast medium).The method allows to determine with high accuracy the place of aneurysm formation, its size, the presence of bleeding, and so on.
• CT and MRI angiography. They are considered less informative than classical angiography, but less invasive. Conducting an MRI does not give a radiation load, which can be a decisive factor for the patient in choosing a study( but for a doctor it is better to get the results of an x-ray study).

Diagnosis of renal artery aneurysm on CT:

Treatment of

When an aneurysm of the renal artery is detected, surgical intervention and an operation to remove pathology are necessary.

There are several treatment methods that are selected individually depending on the size, shape and health of the patient:

1. Prosthetics of the artery. The site of the renal artery with an aneurysm is completely excised. The integrity of the artery is restored using a special prosthesis or a portion of a healthy vessel taken from the patient.
2. It is considered a classical operation, has long been used in cavitary surgery.
3. Aneurysm clipping is the imposition of a special clamp on the isthmus of the aneurysm. This makes it possible to exclude saccular formation from the circulation, thereby preventing the possible formation of blood clots.
4. Switching off the artery and bypassing the kidney. The operation is performed to create a new renal artery from the materials( vessels) taken from other parts of the patient's body.
5. Endovascular strengthening of the aneurysm area with high-strength surgical gauze. This is a minimally invasive method of surgical treatment of an aneurysm of small size, aimed at preventing its proliferation.
6. Nephrectomy( removal of the kidney).It is performed in severe cases of renal aneurysm with developed necrosis.

On the video about the surgical treatment of renal artery aneurysms:

Rehabilitation

The rehabilitation period depends on the severity of the operation. After strengthening the aneurysm wall with surgical gauze or clipping of the aneurysm cervix, rehabilitation is quick - from a week. These operations are preferable, because they do not need an extensive operating field, are easier to tolerate by patients and have fewer contraindications.

It is recommended healthy food, fresh vegetables, fruits, lean meat. The diet is shown, sparing kidneys( with the lowered maintenance of table salt).The use of liquid in the first few months is limited to 1-1.5 liters, including soups and juices. The consumption of protein foods and bread is limited.

Complications of

The most formidable complication of the renal artery aneurysm is its rupture. This can lead to negligent attitude to the annual surveys, which must be passed to each person. Unwillingness to perform surgical treatment or removal of an aneurysm also leads to its increase and to rupture.

Because of compression of surrounding soft tissues, an aneurysm of the renal artery can affect trophic disturbances and kidney function. This will entail renal failure, severe hypertension, can even lead to a heart attack and almost necrosis of the tissues.